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Organization
SOUTH PARK FAMILY DENTAL CARE PA
Active
Organization
SOUTH PARK FAMILY DENTAL CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIVA IZADDOUST D.D.S. (PRESIDENT)
(210) 927-1400
Entity
Organization
Contact information
Practice address
2310 SW MILITARY DR, STE 406, SAN ANTONIO, TX 78224-1407
(210) 927-1400
(210) 927-6330
Mailing address
2310 SW MILITARY DR, STE 406, SAN ANTONIO, TX 78224-1407
(210) 927-1400
(210) 927-6330
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/16/2007
Last updated
05/24/2011
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